Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges

Abstract

Post-traumatic stress disorder (PTSD) is arguably the most common psychiatric disorder to arise after exposure to a traumatic event. Since its formal introduction in the DSM-III in 1980, knowledge has grown significantly regarding its causes, maintaining mechanisms and treatments. Despite this increased understanding, however, the actual definition of the disorder remains controversial. The DSM-5 and ICD-11 define the disorder differently, reflecting disagreements in the field about whether the construct of PTSD should encompass a broad array of psychological manifestations that arise after trauma or should be focused more specifically on trauma memory phenomena. This controversy over clarifying the phenotype of PTSD has limited the capacity to identify biomarkers and specific mechanisms of traumatic stress. This review provides an up-to-date outline of the current definitions of PTSD, its known prevalence and risk factors, the main models to explain the disorder, and evidence-supported treatments. A major conclusion is that, although trauma-focused cognitive behavior therapy is the best-validated treatment for PTSD, it has stagnated over recent decades, and only two-thirds of PTSD patients respond adequately to this intervention. Moreover, most people with PTSD do not access evidence-based treatment, and this situation is much worse in low-and middle-income countries. Identifying processes that can overcome these major barriers to better management of people with PTSD remains an outstanding challenge.

Latent classes of DSM-5 acute stress disorder symptoms in children after single-incident trauma: findings from an international data archive

“…Our second main finding that female gender, younger age, lower parental education, and exposure to interpersonal violence or RTA predicted membership of the high or intermediate symptoms class are in line with earlier studies both in adults (Brewin et al, 2000;Bryant, 2011Bryant, , 2019Olff, 2017) and children (Alisic et al, 2014;Trickey et al, 2012). This is especially notable in that these previous studies focused on prevalence rates or mean symptom levels of ASD or PTSD, instead of latent classes of individuals based on ASD symptoms.…”

Post-traumatic stress disorder as a risk factor for dementia: systematic review and meta-analysis

“…This indicates that PTSD might be a prodrome of dementia and that brain vulnerability remains silent over many years. 8 Only one study reported no significant association between PTSD and dementia. 24 Roughead et al 24 stratified their data by antipsychotic use and found that patients with PTSD who were prescribed antipsychotics had an increased risk of dementia compared with controls without PTSD and being prescribed antipsychotics.…”

“…Additionally, the use of different definitions and classifications of PTSD across studies means that cut-offs will differ, influencing diagnosis or 'caseness'. 8 Implications for the future Future studies are needed to examine the specific contribution of environmental, trauma-related and neurocognitive mechanisms and how these may interact in increasing vulnerability to cognitive decline. 8,34 Further studies are required to address how the use of different classifications of both PTSD and dementia may influence the estimate of the effect.…”

“…7 Symptoms of PTSD, such as re-experiencing the traumatic event, avoidance and hypervigilance, often remain untreated for years, resulting in a chronic condition severe enough to affect daily functioning. 8,9 PTSD is understood to arise as a result of strong negative appraisals of the trauma and disturbances in autobiographical memory. 10 Recent studies show that PTSD is associated with poor cognitive outcomes in several neurocognitive domains, such as processing speed, attention and working memory.…”

Does requiring trauma exposure affect rates of ICD-11 PTSD and complex PTSD? Implications for DSM–5.

“…Does requiring trauma exposure affect rates of ICD-11 PTSD and complex PTSD? Implications for Posttraumatic stress disorder (PTSD) is a distinctive psychiatric condition as it requires an etiologic event -traumatic exposurefor a diagnosis to be made (Bryant, 2019).…”